Guidelines for perinatal care 8th edition free download

About the Authors. Editor: Ronald E. Editor: Frank R. Related Items. Published: Price: Member Price: Member Price: 0. Price: 0. You May Also Like. Member Price:. Pediatric Nutrition, 8th Edition [eBook]. Price Placement of windows and other structural items shall allow for ease of operation and cleaning. Airborne infection isolation rooms shall have a permanently installed visual mechanism to constantly monitor the pressure status of the room when occupied by a patient with an airborne infectious disease.

The mechanism shall continuously monitor the direction of the airflow. An airborne infection isolation room adequately designed to care for ill newborns should be available in any hospital with an NICU. In most cases, this is ideally situated within the NICU, but in some circumstances, utilization of an airborne infection isolation room elsewhere in the hospital for example, in a pediatric ICU would be suitable.

At least one single-occupancy isolation room should be available for any infant with a suspected airborne infection. A space within the NICU should also be available to safely cohort a group of infants infected with or exposed to a common airborne pathogen. When not used for isolation, these rooms may be used for care of noninfectious infants and other clinical purposes. Turbulence attendant to high air-exchange rates can result in unacceptable levels of background noise in airborne infection isolation rooms.

Such levels result in speech interference, annoyance and physiologic responses typical of noise exposure for adults and infants.

Glass partitions should be limited to that which is actually necessary for safe visualization. Operating rooms in health-care facilities where infant procedures may be performed shall be constructed to operating room specifications except for the following modifications:. However, light sources meeting the color rendering index CRI and gamut area index GA values identified in Standard 22 are recommended.

The acoustic environment set forth in Standard 27 shall be the basis for all design choices except for the necessary hard cleanable room surfaces. No effort need be made to achieve this standard in adjacent spaces if doors are expected to remain closed during most of the procedures. Specialized procedure spaces or rooms within the NICU shall be constructed to achieve all of the above, as well as all of the requirements for an infant bed space elsewhere in these Recommended Standards, except for the following additional modifications:.

Each procedure area must be physically separated from other areas so that during surgery or procedures patient and staff flow may be strictly controlled. Air flow must be designed so as to not disrupt the air curtain around the surgical field, and shall be adjustable so as to be able to increase to 15 changes per h during procedures, and then return to baseline values set forth in Standard A scavenging system to vent waste inhalation anesthesia and analgesia gases is required.

These rooms shall be designed to comply with safety requirements for performance of laser surgical procedures. It is assumed that infants having surgery in the NICU will be operated on and recover in their own beds and that surgical personnel will bring needed sterile surgical equipment and supplies to the NICU. Therefore, no additional recovery or postanesthesia areas are required nor are work areas for storage and processing of surgical instruments and separate corridors leading to the operative area.

However, support areas for storage of clean and sterile surgical supplies shall be provided, and a scrub station shall be provided near the entrance to each procedure room in a corridor limited to authorized personnel and patients.

Ambient lighting recommendations set forth in Standard 22 shall be followed except where higher illuminances are required as set forth in IES recommendations for operating rooms. Standard operating room environments may be temporarily modified to better accommodate term infants requiring surgery, but cannot be made optimal for some term and preterm infants, nor can the problems associated with transporting less stable infants away from the intensive resources of the NICU be avoided.

There is now sufficient experience to conclude that certain procedures can be performed in the NICU without compromising patient safety or outcomes. It is now also evident that the environment currently recommended for NICU design may have a positive impact on infant outcomes. This Standard now makes provision for infants requiring surgical procedures to be similarly benefited. Mechanical requirements at each infant bed, such as electrical and gas outlets, shall be organized to ensure safety, easy access and maintenance.

There shall be a minimum of 20 simultaneously accessible electrical outlets. The minimum number of simultaneously accessible gas outlets is:. There shall be a mixture of emergency and normal power for all electrical outlets per current National Fire Protection Association recommendations.

A system that includes easily accessible raceways for electrical conduit and gas piping, work space and equipment placement is recommended because it permits flexibility to modify or upgrade mechanical, electrical or equipment features. All outlets should be positioned to maximize access and flexibility and minimize repetitive movements such as bending and stretching by the staff.

Standard duplex electrical outlets may not be suitable, as each outlet may not be simultaneously accessible for oversized equipment plugs. The number of electrical, gas and suction outlets specified is a minimum; access to more may be necessary for critically ill infants. This area should also include communication devices, supply storage and charting space, resulting in an efficient, organized and self-contained workstation around the infant.

A minimum of six air changes per hour is required, with a minimum of two changes being outside air. The ventilation pattern shall inhibit particulate matter from moving freely in the space, and intake and exhaust vents shall be situated to minimize drafts on or near the infant beds. Prevailing winds or proximity to other structures may require greater clearance.

This application of heat may also alleviate the conditions leading to condensation on these walls. The air flow pattern should be at low velocity and designed to minimize drafts, noise levels and airborne particulate matter. A high-efficiency particulate air HEPA filtration system may provide improved infection control for immunocompromised patients. Because a regular maintenance program is necessary to assure that systems continue to function as designed after occupancy, NICU design should attempt to maximize the ease of maintenance while minimizing its cost.

Handwashing sinks shall be large enough to control splashing and designed to avoid standing or retained water. Space for pictorial handwashing instructions shall be provided above all sinks. There shall be no aerator on the faucet. Walls adjacent to handwashing sinks shall be constructed of nonporous material. Space shall also be provided for soap and towel dispensers and for appropriate trash receptacles. Towel dispensers shall operate so that only the towel itself need be touched in the process of dispensing, and constructed in such a fashion as to control noise as per Standard Handwashing facilities located at a level where they can be used by people in wheelchairs shall be available in the NICU.

Proper hand hygiene is a key component in the prevention and reduction of spread of infection in health care settings. Alcohol-based hand rubs have been shown to be more effective than soap-and-water handwashing in decontaminating hands that are not visibly soiled. Alcohol-based hand rub dispensers can be easily located at sites where hand hygiene is required.

Handwashing sinks are also required in close proximity to infant spaces to be used when hands are soiled or contaminated with body fluids. Sinks for handwashing should not be built into counters.

Sink location, construction material and related hardware paper towel and soap dispensers should be chosen with durability, ease of operation, ease of cleaning and noise control in mind. Nonabsorbent wall material should be used around sinks to prevent the growth of mold on cellulose material. Local, state and federal regulatory agencies dictate what health-care-generated waste is biohazardous or non-biohazardous and appropriate disposal methods that are dependent on the type of waste.

Depending upon the jurisdiction, biohazard signage may need to be affixed. Distinct facilities shall be provided for clean and soiled utilities, medical equipment storage and unit management services. Unless used only as a holding room, this room shall contain a counter and a hands-free handwashing station separate from any utility sinks.

The handwashing station shall have hot and cold running water that is turned on and off by hands-free controls, soap and paper towel dispensers, and a covered waste receptacle with foot control. A designated area for collection of recyclable materials used in the NICU shall be established. An additional separate area or desk for tasks such as compiling more detailed records, completing requisitions and telephone communication shall be provided in an area acoustically separated from the infant and family areas.

Dedicated space shall be allocated as necessary for electronic medical record keeping within infant care areas. Storage areas: A three-zone storage system is desirable.

The first storage area should be the central supply department of the hospital. The second storage zone is the clean utility area described in the standard; it should be adjacent to and acoustically separated from the infant care area.

Routinely used supplies such as diapers, formula, linen, cover gowns, charts and information booklets may be stored in this space. Total storage space may vary by unit size and storage system. Bedside storage should be designed for quiet operation. Hospitals contribute significant waste each year to incinerators and landfills. This creates not only an environmental hazard, but also conditions that are harmful to human health. Providing a designated collection area enables staff to separate and store for collection waste such as paper, newsprint, corrugated cardboard, plastics, metals, batteries, fluorescent lamps and glass to either facilitate existing hospital procedures for recycling or initiate a recycling system.

Space within the designated collection area may also be used for collection of medical supplies for distribution to hospitals or clinics in need of such materials. In addition, there should be one or more staff work areas, each serving 8 to 16 beds. These areas will allow groups of 3 to 6 caregivers to congregate immediately adjacent to the infant care area for report, collaboration and socialization without impinging on infant or family privacy. Charts, computer terminals and hospital forms of the infants may be located in this space.

Design of the NICU must anticipate use of electronic medical record devices so that their introduction does not require major disruption of the function of the unit or impinge on space designed for other purposes. Design considerations include ease of access for staff, patient confidentiality, infection control and noise control, both with respect to that generated by the devices and by the traffic around them.

Laundry room : If laundry facilities for infant materials are provided, a separate laundry room can serve the functions of laundry and toy cleaning within the NICU. Infant clothing and the cloth covers of positioning aids should be laundered on a regular schedule and as needed. In addition, toys utilized by infants or siblings are required to be cleaned on a regular schedule for each infant and between infants.

Space for a commercial-grade washer and dryer should be accommodated. The dryer should be vented through an outside wall. The placement of a commercial-grade dishwasher could promote the efficiency and effectiveness of the aseptic cleaning process for toys.

Space shall be provided within the NICU to meet the professional, personal and administrative needs of the staff. Rooms shall be sized and located to provide privacy and to satisfy their intended function.

Locker, lounge, private toilet facilities and on-call rooms are required at a minimum. Support elements can be defined as those that facilitate the provision of infant care and the well-being of the staff; they may account for at least one-third of the floor space of the entire unit. Staffing areas are defined as space limited to use by staff members to meet personal, professional and administrative needs. These areas include lockers, lounges, counseling, education and conference space and on-call rooms that provide privacy and satisfy their intended function.

Distinct support space shall be provided for all clinical services that are routinely performed in the NICU. Space for preparation and storage of formula and additives to human milk and formula shall be provided within the unit or other location that is away from the bedside. Hospital food preparation design guidelines shall be followed. When the functional program requires a separate room, the room shall include the following areas that can be separated in individual rooms or combined:.

Provisions shall be included for human milk storage. Human milk may be stored in a designated space in the infant feeding preparation room, and in designated spaces on the patient unit. Ancillary services such as but not necessarily limited to respiratory therapy, laboratory, pharmacy, radiology, developmental therapy and specialized feeding preparation are common in the NICU.

Distance, size and access are important considerations when designing space for each of these functions. Satellite facilities may be required to provide these services in a timely manner.

Unless performed elsewhere in the hospital, a specialized feedings preparation area or room should be provided in the NICU, away from the bedside, to permit mixing of additives to breast milk or formula.

The cleanliness of the floor surface, walls and ceilings should be easily maintained. Floor drains are not recommended unless required by local code.

Adequate sinks, electrical outlets and storage should be provided based on the individual hospital facility needs. The use of a laminar flow hood is a decision that each hospital should make. Pharmacies are not required to use laminar flow hoods to prepare oral medications. Powdered formulas are not sterile, and preparing them under a laminar flow hood does not improve the sterility of the product. All water supplied for feeding preparation should meet Federal Standards for drinking water and be commercially sterile.

Commercially sterile water is preferred because it has eliminated pathogenic and other organisms that, if present, could grow in the product and produce spoilage under normal conditions of handling and storage. Administrative space shall be provided in the NICU for activities directly related to infant care, family support or other activities routinely performed within the NICU.

A wide range of personnel are assigned to the NICU, many of whom require office or administrative space. When planning the NICU, administrative space should be considered for each discipline that provides service to the unit on a daily basis and needs a distinct area for carrying out their responsibilities, even if that individual has additional office space elsewhere.

Space shall be provided in or immediately adjacent to the NICU for the following functions: family lounge area, lockable storage, telephone s and toilet facilities. Separate, dedicated rooms shall also be provided for lactation support and consultation in or immediately adjacent to the NICU. A family library or education area shall be provided within the hospital. Family lounge area: This should include comfortable and moveable seating, as well as a play area stocked with entertainment materials for children.

A nourishment area should also be considered, as well as external windows or skylights. Lockable storage: Secure storage for personal items should be provided at each infant space. Lactation support: Comfortable seating, a handwashing sink and a means of communication to the NICU should be provided.

Family education area : This should include publications, audiovisual resources and Internet access so that families can learn about health conditions, child development, parenting issues and parent-to-parent support.

This area might also include space and supplies to learn about and practice caregiving techniques. Telephones : Telephones should be provided that offer privacy and that enable an individual to sit down while talking. Consultation room : This should include comfortable seating and allow complete visual and acoustic privacy. Family—infant room s shall be provided within or immediately adjacent to the NICU that allow s families and infants extended private time together.

The room s can be used for other family support, educational, counseling or demonstration purposes when unoccupied. Access to family—infant room s encourages overnight stays by parents and the infant in the NICU.

The room s should be sufficiently equipped and sized to accommodate the parents, with additional space for a physician, nurse, social worker, chaplain or other individuals who may need to meet with the parents and baby in private.

For security reasons, transition room s should be situated within an area of controlled public access. The number of electrical, medical gas and suction outlets specified will be dependent on the function s intended for this area.

Sufficient family—infant rooms should be provided to allow those families who wish to room in with their infants the opportunity to do so. Ceilings shall be easily cleanable and constructed in a manner to prohibit the passage of particles from the cavity above the ceiling plane into the clinical environment. The ceiling construction in infant rooms and adult sleep areas and the spaces opening onto them shall not be friable and shall have a noise reduction coefficient NRC of at least 0.

To ensure protection from noise intrusion, ceilings in infant rooms and adult sleep areas shall be specified with a ceiling articulation class CAC Finishes shall be free of substances known to be teratogenic, mutagenic, carcinogenic or otherwise harmful to human health. As sound abatement is a high priority in the NICU, acoustical ceiling systems are desirable, but must be selected and designed carefully to meet this standard. In most NICUs, the ceiling offers the largest available area for sound absorption.

The Standard for ceiling finishes includes areas that communicate with infant rooms and adult sleep areas for example, hallways, corridors, storage and staff work areas when doors are opened in the course of daily activity. Ceilings with high acoustical absorption that is, high NRC ratings do not necessarily have a significant barrier effect that is, offer protection from sounds transmitted between adjacent areas.

A CAC provides a moderate barrier effect and allows a broad range of ceiling products. Poor barrier effects can result if room-dividing partitions are discontinued above the ceiling, allowing room-to-room cross-talk, or if there are noise-producing elements in the ceiling plenum. If the ceiling plenum contains noise sources such as fan-powered boxes, in-line exhaust fans, variable air volume devices and so on, then a higher CAC than CAC may be necessary.

Volatile organic compounds VOCs and persistent bioaccumulative toxins PBTs such as cadmium are often found in paints and ceiling tiles and should be avoided. Specify low or no VOC paints and coatings. Wall surfaces shall be easily cleanable and provide protection at points where contact with movable equipment is likely to occur.

Surfaces shall be free of substances known to be teratogenic, mutagenic, carcinogenic or otherwise harmful to human health. As with floors, the ease of cleaning, durability and acoustical properties of wall surfaces must be considered.

Although commonly used, many vinyl wall coverings contain PVC and will degrade indoor air quality, and thus should be avoided.

VOCs and PBTs such as cadmium are often found in paints, wall coverings, acoustical wall panels and wood paneling systems and also should be avoided. Flooring materials shall be free of substances known to be teratogenic, mutagenic, carcinogenic or otherwise harmful to human health. Although ease of cleaning and durability of NICU surfaces are of primary importance, consideration should also be given to their glossiness the mirror-like reflectivity of a surface , 11 their acoustical properties and the density of the materials used.

Reduced glossiness will reduce the risks from bright reflected glare; acoustic and density properties will directly affect noise and comfort. Materials should permit cleaning without the use of chemicals that may be hazardous, as it may not be possible to vacate the space during cleaning. Transition surfaces that do not obstruct mobility, are durable and minimize noise and jarring of equipment should be provided at the intersection of different flooring materials.

Materials suitable to these criteria include resilient sheet flooring medical grade rubber or linoleum and carpeting with an impermeable backing, heat or chemically welded seams and antimicrobial and antistatic properties. Small floor tiles for example, inch squares have myriad seams and areas of nonadherence to the subfloor. These harbor dirt and fluids and are a potential source of bacterial and fungal growth. Much is known regarding the effects of chemicals such as mercury on human health and development.

PVC or vinyl is common in flooring materials including sheet goods, tiles and carpet. The production of PVC generates dioxin, a potent carcinogen, and fumes emitted from vinyl degrade indoor air quality. Dioxin releases are not associated with materials such as polyolefin, rubber latex or linoleum.

VOCs such as formaldehyde and chlorinated compounds such as neoprene should also be avoided when selecting adhesives or sealants for floor coverings. Specify low or no VOC and nontoxic and noncarcinogenic materials. Flooring containing natural rubber latex should be certified nonallergenic by the manufacturer. Infants should not be moved into an area of newly installed flooring for a minimum of 2 weeks to permit off-gassing of adhesives and flooring materials.

Built-in and freestanding furnishings such as cabinets and carts, especially those in the infant care areas, shall be easily cleanable with the fewest possible seams in the integral construction.

Exposed surface seams shall be sealed. Furnishings shall be of durable construction to withstand impact by movable equipment without significant damage. Furnishings and materials shall be free of substances known to be teratogenic, mutagenic, carcinogenic or otherwise harmful to human health. Countertops should have the fewest possible seams. Corners created at wall or backsplash intersections should be coved.

Intersections with sinks or other devices should be sealed or made integral with the top. Casework construction should not chip or flake when struck by objects in the normal routine of infant care, and should be of sufficient moisture resistance to prevent deterioration.

Furnishings in the NICU are often composite pieces made of various parts and layers of materials that are assembled with glue or adhesives. Materials and substances typically used in these furnishings often contain VOCs such as formaldehyde, which is frequently found in pressed wood products including plywood and particle board. Vinyl-based laminates, which are often applied to the surface of pressed wood products, also contain VOCs such as PVC. Specifying furnishings and materials from regional sources within a to mile radius not only provides support for the local community, but also reduces the amounts of fossil fuels necessary for transport.

Both natural and electric light sources shall have controls that allow immediate darkening of any bed position sufficient for transillumination when necessary. Electric light sources shall have a CRI 8 of no less than 80, and a GA 9 of no less than 80 and no greater than The optical reflectors in the luminaires light fixture shall have a neutral finish so that the color-rendering properties of the light source are maintained.

The sources shall avoid unnecessary ultraviolet or infrared radiation by the use of appropriate lamps, lens or filters. No direct view of the electric light source or sun shall be permitted in the infant space as described in Standard 5 : this does not exclude direct procedure lighting, as described in Standard Download e-Book.

Posted on. Page Count. New in the 8th editon: New section on suggested levels of maternal care from birth centers to Level IV institutions New sections on screening for preterm delivery risk added to chapter on antepartum care New topics covered include the timing of cord clamping, the need or not for bedrest, and updates in hypertension Guidance regarding postpartum contraception recommendations has been expanded New section on mosquito-borne illnesses including Zika New section on infections with high-risk infection control issues Updated recommendations on neonatal resuscitation, screening and management of hyperbilirubinemia, and neonatal drug withdrawal.